I completely agree! Thank-you so much for speaking up. A single payer plan would greatly enhance the
quality of life of patients in the U.S., in my estimation..

bruce bodner

01/30/14

Here's a thought :
Why don't we see how single payor works in the people's republic of Vermont before putting the rest of
the country under the yoke of yet another Federal program..

central texan

01/30/14

It would enhance the quality of life for all, most particularly rural hospitals and critical care givers for
whom competitive market measures of cost control and shopper attraction are irrelevant and in direct
conflict with providing healthcare. Medicine is just not the same thing as the mall. Thanks to the authors
for standing up..

susan payson, DO

01/30/14

Pardon me-the data from single payer systems in other countries
does NOT show improved health outcomes, they show the opposite.
Interesting this is written by oncologists since in single payer
systems cost savings are seen through the limitation of services to
the truly ill such as those with cancer. I wonder how many
government trolls have been assigned to cheer on this piece in this
comment area..

DrGMG

01/30/14

Yes, because Medicare is horrible and everyone who has it hates
it....

Colenso

01/30/14

Interesting that the
only negative
comments here are an
ad hominem attack by
Bruce Bodner on the
people of the State
of Vermont who have
chosen to implement
a single payer
model, and by Susan
Payson DO who, using
the rhetorical
device of openly
wondering, in effect
accuses anyone in
this comment area
who supports such a
model of being a
'government troll'.
Whatever the merits
and pitfalls of
single payer
systems, and no
doubt there are
many, posters on
both sides of the
debate need to put
their arguments
without resorting to
personal abuse or to
outlandish
conspiracy theories.
In line with this,
MedPage Today should
have a policy of
zero tolerance for
any poster who
indulges in ad
hominem attacks in
these forums, except
in the rare instance
that a personal
attack is
appropriate and
justified. The same
should apply to
conspiracy theories
for which no proper
evidence is
submitted by their
proponents (as of
course is almost
always the case)..

john pickett

01/30/14

I'm not a physician, but I've worked in healthcare as a USN medic,
respiratory therapist and clinical perfusionist for the last 40
years. My experience has been that "single payer" (government)
healthcare, while attractive on the face of it, always results in
higher costs and lower care. I would suggest the authors and anyone
reading this comment look at the opinion of this physician.
http://www.kevinmd.com/blog/2014/01/toxicity-medicaid.html.

craig amnott

01/30/14

I spent 20 years in a single payer system (The U.S. Army). It's not
better. A single payer system is not the panacea it is touted as
being. Ask the former Soviet Union how a single payer system worked
for them. Be careful what you ask for. You just may get it..

Curious

01/30/14

Somehow missing from this article are a few facts.
Like how many patients with cancer don't get treated, don't get the
best treatments and how has the overall cancer mortality rate gone
down in the past 20 years.
OR, why does oncologists complain about drug prices now when they
have been this way since 1987 when the Reimportation Act was
passed? But even more interesting is what do these physicians do
when Cancer is cured? That's the goal isn't it? And as oncologist
where do they mention that proven generic cancer medicines are in
short supply causing new drug trails to be changed or curtailed as
well as oncologists not being able to continue treatments.
Perhaps they can find out why the FDA is shutting down production
in U.S. facilities that exacerbates the problem in their field,
rather than complaining 27 years later about our being charged too
much for drugs or all kinds.
President Obama was against the Reimportation Act as a candidate
but quickly changed his mind with his PhRMA deal, on this and most
other pharmacy issues, which will come back now that ObamaCare is
in effect for real!.

Rich C.

01/30/14

I second their call and extend the moral and ethical obligations to
include salary reductions for oncologists like Drs. Einhorn and
Derasga. to $ 110,000/year as humble federal servants and caretakers
of humanity..

maura

01/30/14

Susan Payson, DO. You hit the nail on the head...thank you!.

Critical care doc

01/30/14

Maybe the oncologist should first look in the mirror!!! I do not
know how many times I have seen them push wasteful futile care even
bullying families by guilt into therapies to only prolong the
suffering of their loved ones. I guess one advantage of a single
payor system would be to stop this abuse as the government would
take this decision making process out of their hands and make it
for them. But do we really want to trust the government to do
that? The oncologist need to take a more reasonable approach to
their limits as to what they can truly accomplish and look at the
whole patient. Then the quality of care, cost and outcomes will
improve. How else to explain the better outcomes seen with the
Paliative Care Paradox?.

karen whitson

01/30/14

I'm curious about how a single payer system would work. In a single
payer system, if I wanted a cancer treatment that was not covered by
the single payer (perhaps they don't feel there is enough evidence
of efficacy and safety to pay for it), would I be allowed to elect
for that treatment and pay for it myself (perhaps others do believe
there is enough evidence that the treatment could benefit me)? Or
would it be illegal for me to do so? If not illegal, there would
always be other options then. I could pay for it myself or other
business models of insurance would form to cover this type of care.
Or by single payer system, do we mean a single entity decides what
care is offered and it's illegal to provide or purchase care outside
of this system?.

Pat H, RN

01/30/14

I agree that socialized medicine is more discriminatory
towards those who are older and have worked all their
lives, paid for Medicare (since I was 17), and now able
to use it must suffer watchful neglect because of the
age restrictions that are inherent with single payer.
My friends have already received their ACA letters
stating that they must agree to the protocols or their
doctor cannot treat them. They receive their care from
a large group associated with a university based
hospital system..

DDSR

01/30/14

I find it difficult
to believe that
independent
oncologists wrote
this article.
Experience with
other countries have
shown that, with
single payer
systems, physicians
make less money,
have their treatment
options curtailed,
and patients receive
reduced levels of
care with
predictably worse
outcomes. It seems
the only people
winning in a single
payer system are the
government officials
administering it..

Molly_Rn

01/30/14

Yeah! Finally someone had the courage and the good sense to propose
this. Healthcare should be a right not a privilege. Have just been
in three European countries with universal healthcare for business
(healthcare business) and spoke with physicians and nurses and they
would never trade for our fee for service. Susan Payson, DO, you
are talking politics and they are talking about patient care and
their profession. This is just good
common sense. No one, let me repeat, no one should go without good
health care because they are poor. No one should be bankrupted
buying health care. .

Margaret Houlehan

01/30/14

I trust someone I can vote out of office more than I do the CEOs of
BCBS and Aetna.
Thank you, doctors, for your courage in speaking out. Yeah, go
ahead, call me a "socialist."
There is a reason Tommy Douglas is revered in Canada..

rmcgarry, md

01/30/14

Single payer medicare aka "the Canadian system" is clearly not
working in Canada. Wait lists are huge. Access to new drugs
restricted. Oncologists cut corners or patients go out of country
for better care (see Calgary Herald, January 2014 concerning
orthopedic surgery). The wait time in Alberta for a simple
colonoscopy for colon cancer screening is up to 2 years (Calgary
Herald, November 2013). Ontario runs a website that lists all the
government-run cancer centers by wait times. Physicians within the
two-tier British system are questioning the viability of their own
national health system.
More government regulation or "management" of health care in the
U.S. is bad for all patients..

AnonOmouse

01/30/14

Single-payer is
obviously the best
way to go. What do
insurance companies
add to medical care
other than costs?
They are expensive
middle-men that need
to go. I have
received health care
services in other
countries and
frankly, the service
was more thorough,
efficient and
effective--- and it
costs less. Some
people are just
afraid of change,
even when it is in
their best
interests..

Meyati

01/30/14

As a Medicare patient-I agree with the authors. I also was a
military wife for 37 years, and I don't agree with comments about
military care. My husband was enlisted.
I'm at a good clinic-with really good doctors. Medicare is excellent
in paying for my cancer treatment and follow-up, but I do not get
decent primary care under medicare. Earlier this month, I told my
head oncologist that this system is doing everything to provide
really great cancer care-fought the demon into remission, but
primary care left my out of range thyroid untreated for at least 9
months, and I had strep from May to October. Basically, Medicare
ended up paying about $10,000 for something that should have been
cured for less than $200.
Apparently most providers here think that 71 year olds are exempt
from strep. I ran into an 88 year-old that ran a strep test on
anybody that complained of a sore throat. It was very acute. The med
just didn't work- It gave me relief for several weeks. I think that
having radiation during the winter and having cancer made my immune
system sort of puny.
So when we talk about quality of Medicare, we need to define if the
neglect is in oncology or primary care.
I agree that oncologists can be bullies. I fired a jerk bully-I told
all concerned that I was not desperate to live. I'm not suicidal,
but I have limits on what I'll do to live.
OK-I know that all of you are smirking. I'm terrified of the pain. I
watched my father die when I was 13. I took some night classes. I
saw a classmate at a bus stop. I began taking her home-I'd go in and
have coffee. One night, when I got out of the car, my pony tail was
grabbed and a 38 special was pressed behind my ear. All I could
think of was that both my mother and my mother-in-law were abusive-
and I had 2 small children at home, and my husband was in 'Nam. I
told my friend to shut up and be still. Her drunk husband liked
that. I asked him if he had a snub nose police special. we went in
so I could look at his guns. After that, I let her out at different
places about half a block away. I've had other close calls, like a
Greyhound bus passing, coming down a hill right at me, and I had a
big rig tail gating me. It was a series of small hills, where you go
down as fast as possible to get up the next hill before
downshifting. I told my daughter that we would die. The bus stepped
on the gas, the truck behind him and me had black smoke coming from
their brakes. I had smoke coming from my pickup and horse trailer,
while I was pulling over as much as I could. I don't want to die,
but I'm not scared to die. So, I won't be bullied by oncologists or
other doctors.
We lost everything when my father died. It all belonged to Los
Angeles County for medical care. There weren't any food stamps. The
family doctor took care of us for free. He began taking care of us
when I was an infant. That sounds stupid and unbelievable today-
doesn't it?.

kyrawolfe

01/30/14

Yes, we most definitely need single-payer - as proposed in H.R. 676 -
Improved and Expanded Medicare for All. 95% of us would pay far, far
less and get high quality, comprehensive benefits with actual access
to care. Mental Health could actually be integrated into the health
care system instead of being an broken system. The more doctors and
other health care professionals speak up, the more patients will
listen and get on board with single payer. After all, patients (which
is really all of us) trust their doctors much more than they trust
their thieving health insurance company..

jim carlin

01/30/14

in my med school interview
I said -in fewer words what this article said
the dean said "you'll never practice in my med school"
lots of resistance to change-but it's coming
j carlin rariologist.

Bill Lee

01/30/14

With single payer, everyone would get the equal and fair bad care that
other single payer programs from Europe and Canada give. Stupid!!.

anthony perry

01/30/14

How about if the government controls all of food, or housing, or
transportation, or energy. Makes about as much sense.
My friend in Canada told me she was going the other day for massage
therapy for her sore neck. No cost. Acupuncture is included also.
But unless it's for something critical the wait for an MRI is 6
months. Only medical academics could be impractical enough to favor
subjecting medical decision-making to political pressures.
Take a good look at the ecomomic problems in our present system
gentlemen. It is most definitely not a free market system. Most of
the high cost and maldistribution is due to government policy.
We all sympathize with those with serious illness but the solution
to that problem is not to subject the whole medical care system to
post office mentality..

alice carroll

01/30/14

I agree with Drs.
Einhorn and Drasga,
single-payer is the
only way to go!
Insurance Co's are
middle-men that
produce nothing but
paperwork and a 20%
profit for
shareholders. It
seems immoral to me
to have shareholders
profit off of the
ill and infirm. It
wasn't this way
until we allowed
corporate-controlled
health care which
brought raising
costs year after
year. The drug
companies must be
reigned in as well,
one cancer drug,
Neulasta cost $8100
a dose and I needed
it 8x's. When you
are a cancer patient
or any patient
fighting for your
life the last thing
you need is the
constant worry about
how you'll pay for
your treatment. In
Europe this is even
in the equation! We
are causing so much
worry and suffering
to our citizens not
to mention
bankruptcies due to
the misfortune of
illness so an
industry and its
shareholders can
profit. How can this
not be wrong?.

Beverly Richards-Smith, PhD

01/30/14

If health insurers,
Medicare and
Medicaid were to
decide not to cover
certain drugs
because of their
tremendous expense
and poor performance
- take a
$100,000/year drug
for seven years to
gain 42 days' longer
survival than with a
cheaper drug (which
also must be taken
with the pricey one)
alone - the battle
cry "Death panels!"
would be heard
throughout the land.
I suspect if
patients were told
just how costly the
drug is, what
additional side
effects they would
suffer, and for how
little benefit, many
would opt not to
take it. The
situation with the
"miracle" leukemia
drug is different in
that it stops the
cancer in its tracks
- for as long as
someone continues
shelling out for it.
It used to be masked
outlaws who said,
"Your money or your
life!" Now it's the
pharmaceutical
companies..

greg g

01/30/14

Good grief. More socialism. What has happened to America? Obama's
"death boards" are already in place, and now these leftist oncologists
are calling for more, more, more. Ask some Canadians how they like
being put on a waiting list for life-saving surgery .... a list
calculated by actuaries, not doctors, to remain long enough so that
many die before their turn comes up. It's murder. May God bless
America, we're going to need it!.

j schwartz

01/30/14

no wonder medicine is dying. Collaborators like this influence policy. If all you can do is answer
questions at a surface emotional level and never get to the etiology of a problem, you will agree with this
guys conclusion. If you actually become educated about the problem beyond the halls of academia and
the major media and actually take care of pts on a daily basis, you realize that centralization of money
and power is the problem NOT the solution. The third party payer induced by our government has
distorted the free market and has lead the the chaos which we now experience. We need MORE payers
not less. The only difference is that we need to empower the individual pt over the system not the
system over the individual. You achieve this thru the free market. The pt gets to choose what kind of
healthcare they want (not the american left like Obama and Emmanuel) and you empower him by letting
them spend his own money to achieve this. This is the ONLY way to humanely keep costs down. All
attempts to centralize money and power whether it be thru 'evidence based medicine' or a 'single payer
system' are akin to treating anemia with phlebotomy. With all due respect to a giant like Dr. Einhorn, he
has lived in a protected liberal academic environment for his entire practicing life. It is different out
here in the streets where we don't have huge endowments and government money to keep us from the
everyday tasks of taking care of human beings..

Gary Jones

01/30/14

Karen Whitson,
If you only knew how poignant your questions are.
"I'm curious about how a single payer system would work. In a single payer system, if I wanted a
cancer treatment that was not covered by the single payer (perhaps they don't feel there is enough
evidence of efficacy and safety to pay for it), would I be allowed to elect for that treatment and pay for
it myself (perhaps others do believe there is enough evidence that the treatment could benefit me)? Or
would it be illegal for me to do so? "
If you remember back when Hillary Clinton, as a first lady, proposed Hillary Care, one of her concerns
was an unfair two tier system. Under HilliaryCare, if it was passed it would have been illegal for a
physician to provide you with care not covered under the single payor system. In Canada, it is ok to
purchase healthcare out of your pocket. So if we had a system like Canada, you would be able to
purchase your treatments, , but you better be a millionaire. Take prostate cancer for example. One
cutting edge treatment, is called Provenge. It is $93,000 for a treatment. Breast cancer, Avastatin
$88,000 per year. None of these include CT/MRI, surgery, and a whole range of other drugs and
therapies often needed for successful treatment of end stage cancers.
If you couldn't afford care in this country, you could always travel abroad, India has some interesting
high volume lower cost models for surgery currently.
If you don't have the money to shell out hundreds of thousands of dollars to pay for your "non-
covered care," or want to travel abroad when you are at your most vulnerable for care in a foreign
land, you may want to think about opposing a government takeover of your health care.
Additionally you may want to read the following paper, Allocation of Scarce Medical Resources, by
Ezekiel Emmanual, MD. He is the brother of Rahm Emmanual, President Obama's former chief of staff.
He is also one of the architects of "Obamacare." In this paper he discusses the complete lives system.
In which, he discusses at age 20 you are most likely to get access to the health care you need, by 50
the probability has dropped dramatically, and over 70 the probability to receive the healthcare you
need drops towards zero.
Currently in the latest healthcare law, the Independent Payment Advisory Board, a non-elected board
majority non-medical professionals who's mission is to keep medicare expenses in check. The IPAB is
duplicitous for many reasons: it shifts health care decision-making power away from the patient; it
will operate without transparency or accountability, bypassing all Congressional oversight; and it
places the focus on slashing Medicare costs, rather than on improving the quality of care. If medicare
costs rise, (the target will be set at the nominal gross domestic product (GDP) per capita + 1.0
percent) the IPAB will propose recommendations to Congress and the President to reduce the growth
rate. The only way to do this is to decrease payments for medical care, or to cut medical care (ration
medical care)..

RN Cancer Care

01/30/14

I am astonished at the people on here who think that a GOVERNMENT
run single payor system would be beneficial to anyonee. Are you
kidding me, in the wake of the disaster known as OBAMACARE I am
shocked that anyone would actually think that it would be great to
have further intrusion into our healthcare. Especially when the
care in countrys with this type of system does not bare this out.
You have to ask yourself why people from other countrys come to the
US for healthcare. We have an international program at our hospital
where people from all over the world--with money of course--come
for US healthcare. I think that some people live in a fantasy land
where everything is perfect and FREE and it will be wonderful for
all. Too bad that doesn't and will never exist..

Molly_Rn

01/30/14

For all of you fearing commies and pinkos under your bed, Joe
McCarthy would love you all, I have single payer and I love it; it
is called Medicare. It is a hell of a lot better than arguing with
a health insurance company that pays it's people to deny me
coverage that I am paying for. And I pay for my Medicare and have
paid into the system ever since it started. It is a good deal..

alice carroll

01/30/14

According to the
World Health
Organization the US
ranks 37th in the
world as a health
care provider. Tied
with Cuba. Number 1
is France. They have
longer life
expectancy and
better over all
care. People in
Europe believe we're
being taken
advantage of for
paying so much for
the cost of care and
cannot believe that
50 million Americans
do not have health
insurance and
therefore receive
substandard care. No
one over there goes
bankrupt due to
health issues. Of
course the rich come
to the US for
certain procedures,
they want those
plush hospitals with
special menus,
pianos in the lobby
and state of the art
rooms. I'd rather
have the
European-style
coverage than
overpay so insurance
companies can keep
their 20% profit
margins..

j schwartz

01/30/14

these are all lies...data from Canada? That's like believing anything from the Institute of Medicine which
is completely politically motivated. These people are dreaming and failing to grasp the reality of
giving control of your life and decision making processes to a potentially corrupt centralized agency.
America has previously existed to prevent the concentration of power and money in one source. The
Founders knew exactly the abuse of the individual that results. It is amazing to me that people smart
enough to cure testicular cancer can fail to understand the root causes of our healthcare crises and the
dysfunction centralization has already caused. How frustrating. If intelligent people can't get it and
support the system over the individual instead of the individual over the system , what hope do we have??
Below are all false conclusions. This is like blaming Wall Street for the mortgage crisis caused by the
repeal of the Glass Steagal Act, enforcement of the CRA and ignoring market forces and allowing the Fed
to keep interest rates too low.
How sad and depressing that intelligent people can be so fooled. Humans are NOT data points
Reduced administrative costs, which currently account for almost a third of healthcare expenditures
Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of
family bankruptcies identified in a 2009 report
Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
Implementation of proven cost-containment strategies, which are absent from the ACA
Improving quality of care and outcomes by increasing access to care
Reverse the trend toward for-profit, investor-owned healthcare plans
Preserve physician's income potential, as judged by experience with the Canadian healthcare system.

Edgar Hoover, MD

01/30/14

This debate about
single payer vs our
existing system
really comes down to
how to provide a
limited commodity
(healthcare) in the
most cost effective
way while still
preserving a good
quality product.
Every country is
currently struggling
with meeting the
high cost of
healthcare. Canada,
for example, spends
significantly less
per capita on
healthcare than we
do in the US. They
do this by limiting
the expensive items
like elective
surgeries or MRI
scans. We achieve
the same end in the
US by insuring only
part of the
population and
providing skimpy
coverage with high
deductibles to many
people. The recent
outrage about people
losing their
"coverage" by
existing plans with
the startup of the
ACA was about losing
this type of skimpy
coverage. The
feeling being bad
insurance is better
than no insurance at
all. I have worked
in the Canadian
system and saw very
little direct
influence by the
"government" on
health care
decisions. In
contrast we are
directly under the
influence of
insurers in
decisions about
healthcare. The
whole Big Brother is
watching idea about
Canadian healthcare
is unfounded. A
simple, direct
single payer system,
not the convoluted
multi-level system
that is our current
medicare managed by
each individual
state should be a
major improvement on
our current
situation..

tom hennessy

01/31/14

The 'house doctor' is what the profession is gravitating towards,
back to the fourteenth century when only the rich could afford a
doctor, and paid them well to insure they had the doctor, thereby
disallowing the rest of the peons from having a doctor. Doctors are
to be treated no different from cab drivers, in that, there are a
limited number of doctors allowed, therefore, when most of the
doctors refuse to work for anyone UNLESS they pay them a premium,
it allows for doctors to sit on their arses holding people hostage
because they would rather work less for more money. Nice job if you
can get it, but, that is why there are licenses. If you don't like
the amount of work you have to do in order to have that job, don't
take the job or else throw the doors open for an unlimited amount
of doctors, flood the market with doctors, half-assed doctors if
need be, because most don't make a decision without the internet
and 'research' beforehand, anything a high school student can
accomplish with relative ease..

greg g

01/31/14

To Molly_RN,
I'm on Medicare too. Since I'm diabetic, I have developed diabetic
neuropathy in my feet and it is severely limiting my mobility. So my
doc prescribed a specially compounded neuropathy cream which came to
$1400.00. My Medicare Part D plan would not cover it. Even though I
own a medical equipment business, revenue is way, way down thanks to
O-care so I have to do without. I have many stories from others
similar to this. Medicare is about as perfect as a five-legged
horse. If the free, open market were the system in place, that
ointment probably would have been around $100.00 due to good, old
American competition. Free markets: misery for a few. Socialism:
misery for ALL..

samc

02/01/14

Everyone should be entitled to a base level of care. A single payer system would cover that well. You
want or need more, you have to pay for it using whatever providers are set up to handle it.
This discussion is seriously short on facts and long on politics and fear..

Molly_Rn

02/01/14

Sorry Greg G, but the same goes for the "free market" healthcare
pre "Affordable Care Act". Know lots of people with migraines that
cannot afford their medication and their health insurance says it
is too expensive so their co-pay is hundreds of dollars per dose. A
single payer, universal healthcare like the Scandinavian countries
have would negotiate with the pharmaceutical companies for a
reasonable price. Universal healthcare (getting rid of the health
insurance industry that does only one thing, manage your money into
their pockets, is just good sense. Get off you Joe McCarthy
everyone is a socialist or a communist if they want to benefit all
of us..

Alice Villalobos, DVM, DPNAP

02/02/14

For profit insurance companies have an inherent conflict of
Interest that chips at profit when they pay claims. Single payer
system would be amazingly and humanely become
Patient centered. What a novel and comforting concept for
Cancer patients and their families! The for profit health care system
In the USA has ravaged the public long enough. Thank
Goodness the ACA has put some ethical guidelines toward
How insurance companies handle human beings with illness
And co morbidities. I applaud the ethical principles
Outlined in this article and it's compassionate authors..

John Spek of Spek Services

02/04/14

Fantastic - great news
Since the U S has a single payer system - we should be all set
Oncologists should have no problem accepting the U S single payer
system in effect in 50 regions -
Medicaid.

John Spek of Spek Services

02/04/14

The uninformed still try to claim Medicare as a single payer program
it's not
With Medicare, and no private coverage added on
all you have is
high deductible,
unlimited 20% outpatient copay,
limited annual benefits,
and no outpatient drug services
and in a medical need, personal bankruptcy is unavoidable
see for yourself - medicare.gov
Medicaid is the U S single payer plan.

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